Provider Demographics
NPI:1942703772
Name:LEVINE, MADELYN REA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:REA
Last Name:LEVINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 S NEGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1218
Mailing Address - Country:US
Mailing Address - Phone:724-787-2054
Mailing Address - Fax:
Practice Address - Street 1:4810 OLD WILLIAM PENN HWY STE 6
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-9468
Practice Address - Country:US
Practice Address - Phone:724-327-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600254122300000X
MI2901022717122300000X, 390200000X
PADS0425641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program